Objectives: For minimally invasive curettage of osteonecrosis of the femoral head, we have developed a novel expandable blade which can be introduced into the femoral head through a subtrochanteric route under surgical navigation. In this study, we evaluated the effectiveness and feasibility of the blade in comparison with a surgical diamond cutter (Cebotome). Background: It has been reported that about 70-80% of hips with osteonecrosis of the femoral head show progression of collapse of the femoral head if they do not receive any operative treatment [3, 4, 7]. In order to attempt to halt progression of collapse and to accelerate the reparative process of the necrotic lesion, various joint preserving procedures have so far been performed. Core decompression with or without bone grafting is the most popular procedure in early stages of necrosis, but it has been reported that 20-40% of hips treated with this procedure in early stages resulted in collapse and needed total hip arthroplasty [2, 5, 6]. It is performed through a lateral subtrochanteric route with a limitation to curette a large lesion through the small core tract except for the trapdoor procedure [1], but the trapdoor procedure is quite invasive because the hip may need to be dislocated. The collapse may be prevented if the necrotic area is curetted thoroughly and filled with reinforcing materials such as fibular grafts, PMMA cement, or bone substitutes with sufficient mechanical strength. In order to curette the necrotic area in the femoral head effectively in a minimally invasive fashion, we have developed computer-assisted curettage with an expandable blade.
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